Comparison of locally made phonating device versus oesophageal speech in postlaryngectomy speech rehabilitation

To compare the effectiveness of locally made phonating device with oesophageal speech as a communication method in a laryngectomized patient. Randomized Controlled Trial. Combined Military hospital Lahore from January 2004 to July 2007. Twenty five patients who had undergone total laryngectomy were divided in two groups by random sampling. 13 patients were placed in experimental group and provided with a locally made phonating device El [Electro-larynx, 'BM Talk'] and speech training with this device started between 20th to 30th post-operative day. The results were compared to a Control Group consisting of 12 laryngectomized patients who were provided instruction and training on oesophageal speech for communication. Speech assessment was made at the end of 2nd, 4th and 6th month post-operatively in both the groups. Assessment parameters were defined according to the patient's ability to communicate ten predetermined sentences of Urdu and Punjabi to a team of three speech assessors on each speech assessment day. Speech communication score was fixed at 100 if all the spoken sentences were fully understood by all the three assessors irrespective of character of speech, while it was 0 if none of the sentence spoken could be understood by any of the three assessors. In between the two were different percentages of speech communication scores depending on the number of sentences understood by the speech assessors. The character of voice was assessed by Visual Analogue Score where variation between robotic and normal speech character were divided into ten grades from 1 to 10. At the end of six months, speech communication score was 76.62 with SD 17.29 for EL [Electro-Larynx]; while for control group [oesophageal speech] it was 34.17 with standard deviation of 8.63. Those score was compared by using t test and was highly significant i.e. <0.001 in favor of EL. The character of voice was closer to normal in case of oesophageal speech compared to EL where it was closer to robotic. Locally made EL [Electro-larynx] 'BM Talk' is a useful device for speech rehabilitation in laryngectomised patient. It has added advantage of local availability and cost effectiveness. The character of voice may be robotic and monotonous, nevertheless full sentence can be communicated with relative ease to the listener, which is more important factor in our setup

Laterality of pleomorphic adenoma of parotid gland

Although pleomorphic adenoma is the commonest benign tumor of both major and minor salivary glands, yet it bears certain peculiar characters like invariable growth rate, short spells of spurts of growth, long quiescent periods, invasion of surrounding tissues by its capsular projections, recurrence, notorious for implantation and classic origin from the tail of parotid gland. Since the nerve of facial expression [facial nerve] falls within the domain of otolaryngologists but its course along with its variable branches through the parotid gland has always remained an area of common interest between general and ENT surgeons. With the more and more involvement of E.N.T. surgeons in head and neck oncology, the cancer of salivary glands looks to be being taken over by them in recent decades. FNAC inspite of its accuracy is loosing its superiority over modern ultrasonography. This is an observational study. This study was carried out in Combined Military Hospital Lahore from Feb 2005 to Feb 2008. A total of 28 patients with unilateral mass of parotid gland, all with FNAC [Fine needle aspiration cytology] positive for pleomorphic adenoma were included in the study without any discrimination of age, sex or size of tumor. Each patient underwent CT scan and surgical modality of treatment was selected for every patient with post-operative histopathology study to confirm or otherwise of FNAC diagnosis. Female male ratio was 3:4, mean age in males was 44, in females was 37. Histopathology-disproved FNAC in 7.14%. Ratio between involvement of superficial lobe and both lobes was 13:1. Post-operative transient facial nerve paresis was seen in 12 out of 28 patients and there was surprising laterality of right parotid involvement, ratio between right and left parotid being 11:3. Smallest tumor at presentation was 3x3 centimeter and largest was 14x10 centimeter in size. Markedly more incidence of pleomorphic adenoma on right side of face is observed. It has not been reported previously. Zero percent facial nerve severance in 28 parotidectomies reflects vigilance and surgical skill of today's otorhinolaryngologists

Post SMR intranasal packing - do we really need it?

Sub mucous resection [SMR] for the deflected nasal septum [DNS] is the commonest nasal surgery all over the world. The unpleasant part of the whole event is postoperative nasal packing for 24 to 48 hours. Handsome numbers of patients delay the operation just to avoid the horrible experience of nasal packs by close friends or relatives. Many a times there is no bleeding at all on termination of operation but we still do nasal packing for the sake of doing it perhaps a fear of reactionary or primary bleed on the back of our mind. A variety of packing materials are being used most of which are not evidence based. This study was conducted at combined military hospital, Lahore over a period of one and half year from June 2006 to December 2007. A total of 72 patients were included in the study having moderate to marked deflection of nasal septum. All patients underwent classical SMR operation under local anesthesia. Only 04 patients were given nasal packs on termination of opearation. All patients were closely monitored for in 02 to 03 hours post operatively. All patients were seen on 2[nd], 5[th] and 15[th] day. 65 [90.27%] patients had no problem. 02 [2.7%] patients reported back with 24 in hours with septal haematoma. The operation was terminated in 01 [1.3%] patient just at the time of incision

Branchial fistula: a rare presentation

Remains of cervical sinus of His may persist as a branchial cyst. A branchial sinus is formed when 2nd branchial arch fails to meet the 5th pharyngeal arch. Peak age for presentation of cysts is in the third decade and that of the congenital sinuses and fistulae is at birth. Rarely a branchial sinus is found to have an internal opening as well, thus forming a true branchial fistula. We present a case of true branchial fistula with external opening on the lateral side of neck and internal opening near the lower pole of tonsil

Efficacy of epley maneuver in BPPV

Benign paroxysmal positional vertigo [BPPV] is one of the most common causes of vertigo. The diagnosis is confirmed by observing a classical response during the Dix-Halipike maneuver. The cause of BPPV is usually idiopathic. There are two popular hypotheses described regarding the pathogenesis i.e. cupulolithiasis and canalithiasis. The clinical course of BPPV is spontaneous recovery in weeks or months. Treatments for BPPV have ranged from no intervention to surgical treatment. The new treatment, "Canal it h-repositioning procedure [CRP]" which was introduced by Epley in 1992 produces a very high rate of success. This treatment has caused interest and has been modified and studied worldwide in recent years. To determine the efficacy of Epley maneuver in BPPV. We recruited 100 patients with a history of positional vertigo and unilateral positional nystagmus on physical examination [Dix-Halipike maneuver]. Patients were randomized to either the Epley [n=50] or a prochlorperazine [n=50]. Measured outcomes included resolution of vertigo and positional nystagmus at follow-up examination. RESULTS: The mean duration of follow-up was 14 days for both groups. In Epley's group resolution of symptoms was reported by 36[72%] of the patients after first visit on single maneuver treatment and by 46 [92%] patients on second visit on repeating maneuver, while 4 patients had minimal symptomatic improvement and were offer other treatment options. While in prochlorperazine group, 11 [22%] patients reported improvement in symptoms on first visit and 17[34%] on second visit and 19 [38%] had improved by 14th day. The Epley's maneuver is safe, economical and effective treatment of benign paroxysmal positional vertigo and this procedure can be performed by general internists on outpatients with this disorder